Provider Demographics
NPI:1619027273
Name:RIDEAU, ROBERT DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:RIDEAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 BOVET RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3125
Mailing Address - Country:US
Mailing Address - Phone:650-627-8191
Mailing Address - Fax:650-627-8192
Practice Address - Street 1:66 BOVET RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3125
Practice Address - Country:US
Practice Address - Phone:650-627-8191
Practice Address - Fax:650-627-8192
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA321701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice